{"id":18378,"date":"2014-11-13T08:01:06","date_gmt":"2014-11-13T07:01:06","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=18378"},"modified":"2014-11-13T08:01:06","modified_gmt":"2014-11-13T07:01:06","slug":"lidem-po-operacich-i-zpevakum-vraci-hlas-rehabilitace","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=18378","title":{"rendered":"Lidem po operac\u00edch i zp\u011bv\u00e1k\u016fm vrac\u00ed hlas rehabilitace"},"content":{"rendered":"

Ztratit \u0159e\u010d m\u016f\u017ee \u010dlov\u011bk nejen po z\u00e1sahu sh\u016fry, jako se to stalo biblick\u00e9mu Zachari\u00e1\u0161ovi. Bez hlasu se ocit\u00e1\u00a0mal\u00e9 procento pacient\u016f po operac\u00edch krku v\u00a0oblasti hrtanu i lid\u00e9, kte\u0159\u00ed si hlasivky namohli p\u0159i sv\u00e9m povol\u00e1n\u00ed. Nemocnice Na Homolce je jedn\u00edm z\u00a0 m\u00e1la zdravotnick\u00fdch za\u0159\u00edzen\u00ed, kter\u00e9 d\u011bl\u00e1 hlasovou rehabilitaci.<\/strong><\/p>\n

Kandid\u00e1ti pro hlasovou rehabilitaci jsou v\u0161ichni, kdo trp\u00ed poruchou tvorby hlasu. Cht\u011bj\u00ed promluvit a nam\u00edsto toho jen \u0161eptaj\u00ed, s\u00edpaj\u00ed, nebo dokonce z\u016fst\u00e1vaj\u00ed n\u011bm\u00ed jako ryby (medic\u00edna m\u00e1 pro tuto \u00faplnou ztr\u00e1tu hlasu odborn\u00fd n\u00e1zev \u201eafonie\u201c). Porucha m\u016f\u017ee b\u00fdt zp\u016fsobena jednak mechanicky \u2013 tedy r\u016fzn\u00fdmi uzl\u00edky, v\u00fdr\u016fstky \u010di polypy, jednak z\u00e1n\u011btliv\u00fdmi chorobami. N\u011bkdy mohou b\u00fdt hlasivky po\u0161kozeny b\u011bhem operace, \u010di si je lid\u00e9 nam\u016f\u017eou v\u00a0pr\u00e1ci, co\u017e dob\u0159e znaj\u00ed u\u010ditel\u00e9, herci a zp\u011bv\u00e1ci. Pr\u00e1v\u011b posledn\u00ed dv\u011b skupiny pacient\u016f – ti s\u00a0probl\u00e9my po operaci a ti, kte\u0159\u00ed sv\u00e9 hlasivky p\u0159\u00edli\u0161 nam\u00e1hali – p\u0159ich\u00e1zej\u00ed, aby znovu nabyli sv\u016fj hlas, na Odd\u011blen\u00ed rehabilita\u010dn\u00ed a fyzik\u00e1ln\u00ed medic\u00edny pra\u017esk\u00e9 Nemocnice Na Homolce.<\/p>\n

\u201eAsi 80 procent na\u0161ich pacient\u016f tvo\u0159\u00ed lid\u00e9 s\u00a0takzvan\u00fdmi poopera\u010dn\u00edmi par\u00e9zami, neboli s obrnou hlasivkov\u00e9ho nervu. Ostatn\u00ed jsou zm\u00edn\u011bn\u00ed u\u010ditel\u00e9 a lid\u00e9 z\u00a0dal\u0161\u00edch profes\u00ed, kde b\u00fdv\u00e1 hlas neust\u00e1le p\u0159et\u011b\u017eov\u00e1n. A l\u00e9\u010d\u00edme i poruchy hlasu vznikl\u00e9 z\u00a0psychogenn\u00edch d\u016fvod\u016f,\u201c vypo\u010d\u00edt\u00e1v\u00e1 fyzioterapeutka Mgr. Zuzana Ku\u010derov\u00e1, kter\u00e1 se svou kolegyn\u00ed Mgr. Magdalenou Sm\u00edlkovou nov\u00e9 pojet\u00ed rehabilitace hlasu na Homolce zavedla. Ta spo\u010d\u00edv\u00e1 ve spojen\u00ed dvou metod: elektrostimulace a hlasov\u00e9 rehabilitace a reedukace.<\/p>\n

B\u011b\u017en\u011b to prob\u00edh\u00e1 tak, \u017ee pacienti s\u00a0poopera\u010dn\u00edm po\u0161kozen\u00edm hlasivek doch\u00e1zej\u00ed zvl\u00e1\u0161\u0165 na elektrostimulace k\u00a0fyzioterapeut\u016fm a zvl\u00e1\u0161\u0165, t\u0159eba jednou za m\u011bs\u00edc, p\u0159ijdou k\u00a0foniatr\u016fm. S\u00a0nimi si hlas procvi\u010d\u00ed a odnesou si pokyny, jak rehabilitovat za pomoci dom\u00e1c\u00edch \u0159e\u010dov\u00fdch cvi\u010den\u00ed. \u201eMy jsme u n\u00e1s za\u010daly prov\u00e1d\u011bt oba zp\u016fsoby rehabilitace sou\u010dasn\u011b a p\u0159ineslo to v\u00fdsledky. Na souboru pacientek jsme prok\u00e1zaly, \u017ee se po\u010det elektrostimulac\u00ed, pot\u0159ebn\u00fdch k\u00a0navr\u00e1cen\u00ed hlasu, sn\u00ed\u017eil o p\u011bt, ze 17 na 12, pokud se k\u00a0nim sou\u010dasn\u011b p\u0159idala i hlasov\u00e1 reedukace,\u201c \u0159\u00edk\u00e1 Mgr. Ku\u010derov\u00e1.<\/p>\n

Jak vznik\u00e1 hlas<\/b><\/p>\n

Hlasov\u00e9, neboli fona\u010dn\u00ed \u00fastroj\u00ed je ulo\u017eeno v\u00a0hrtanu. Jeho z\u00e1kladem jsou dva hlasov\u00e9 valy pokryt\u00e9 sliznic\u00ed, takzvan\u00e9 hlasivky \u2013 napjat\u00e9 vep\u0159edu mezi chrupavkou \u0161t\u00edtnou, kde se navz\u00e1jem po\u0159\u00e1d dot\u00fdkaj\u00ed, a vzadu mezi chrupavkami hlasivkov\u00fdmi. Mezi hlasivkami se vytv\u00e1\u0159\u00ed hlasivkov\u00e1 \u0161t\u011brbina, kter\u00e1 m\u00e1 p\u0159i d\u00fdch\u00e1n\u00ed tvar prot\u00e1hl\u00e9ho, rovnoramenn\u00e9ho troj\u00faheln\u00edku. P\u0159i mluven\u00ed v\u0161ak nap\u011bt\u00ed svalu zp\u016fsob\u00ed, \u017ee se k\u00a0sob\u011b hlasivky p\u0159ibl\u00ed\u017e\u00ed. Hlas pak vznik\u00e1 \u010dinnost\u00ed hlasivkov\u00fdch sval\u016f a vlivem tlaku vydechovan\u00e9ho vzduchu.<\/p>\n

Kdy\u017e se \u0159e\u010d ztrat\u00ed<\/b><\/p>\n

Poopera\u010dn\u00ed obrna hlasivek je zp\u016fsobena \u00fatiskem, nata\u017een\u00edm \u010di jin\u00fdm po\u0161kozen\u00edm hlasivkov\u00e9ho nervu. \u201eHlasivky funguj\u00ed kmitav\u011b, pokud je ale po\u0161kozena jejich inervace, neh\u00fdbou se, jak by m\u011bly,\u201c \u0159\u00edk\u00e1 fyzioterapeutka. Riziko poopera\u010dn\u00edho po\u0161kozen\u00ed hlasivek nen\u00ed vysok\u00e9, asi 3 %. Nej\u010dast\u011bji se to st\u00e1v\u00e1 po operaci \u0161t\u00edtn\u00e9 \u017el\u00e1zy, po operaci kr\u010dn\u00ed p\u00e1te\u0159e, kr\u010dn\u00edch tepen \u010di po chirurgick\u00e9m \u0159e\u0161en\u00ed n\u00e1dorov\u00fdch stav\u016f v\u00a0krku.<\/p>\n

Pacient, kter\u00fd pot\u0159ebuje hlasovou rehabilitaci, nemus\u00ed b\u00fdt jen ten, kdo \u00fapln\u011b p\u0159i\u0161el o hlas. N\u011bkdo nap\u0159\u00edklad nem\u016f\u017ee norm\u00e1ln\u011b mluvit, jen chrapt\u00ed, n\u011bkdo zase \u0161ept\u00e1. \u010cast\u00e1 b\u00fdv\u00e1 du\u0161nost, proto\u017ee jak se hlasivky nedov\u00edraj\u00ed, ztr\u00e1c\u00ed se p\u0159i v\u00fddechu v\u00edce vzduchu, ne\u017e je obvykl\u00e9.<\/p>\n

Jak se hlas navrac\u00ed<\/b><\/p>\n

Pacienta mus\u00ed nejprve vy\u0161et\u0159it ORL specialista. Nejcitliv\u011bj\u0161\u00ed diagnostickou metodou je laryngostroboskopie, endoskopick\u00e9 vy\u0161et\u0159en\u00ed hrtanu. Pokud je potvrzena par\u00e9za hlasivkov\u00e9ho nervu, p\u0159ech\u00e1z\u00ed pacient do p\u00e9\u010de odd\u011blen\u00ed Rehabilitace a fyzik\u00e1ln\u00ed medic\u00edny. Zde je vy\u0161et\u0159en rehabilita\u010dn\u00edm l\u00e9ka\u0159em a d\u00e1le putuje do p\u00e9\u010de fyzioterapeutek, kter\u00e9 posoud\u00ed kvalitu hlasu pacienta. \u201eZ Hudebn\u00ed fakulty AMU m\u00e1me vyp\u016fj\u010den\u00fd p\u0159\u00edstroj na zm\u011b\u0159en\u00ed hlasov\u00e9ho pole. Je to pro n\u00e1s i pro pacienta u\u017eite\u010dn\u00e1 zp\u011btn\u00e1 vazba, proto\u017ee na grafech vid\u00edme, jak se hlas d\u00edky rehabilitaci zlep\u0161uje,\u201c uv\u00e1d\u00ed Mgr. Ku\u010derov\u00e1.<\/p>\n

Ka\u017ed\u00e1 fyzioterapie hlasu je zah\u00e1jena korekc\u00ed spr\u00e1vn\u00e9ho dr\u017een\u00ed t\u011bla pacienta, n\u00e1cvikem spr\u00e1vn\u00e9ho d\u00fdch\u00e1n\u00ed a o\u0161et\u0159en\u00edm jizev u poopera\u010dn\u00edch par\u00e9z, n\u00e1sleduje elektrostimulace po\u0161kozen\u00e9 hlasivky. Pot\u00e9 p\u0159ich\u00e1z\u00ed na \u0159adu vlastn\u00ed rehabilitace a reedukace hlasu. Pacienti chod\u00ed zpravidla t\u0159ikr\u00e1t t\u00fddn\u011b, ze vzd\u00e1len\u011bj\u0161\u00edch m\u00edst republiky ale mohou doj\u00ed\u017ed\u011bt jen dvakr\u00e1t nebo jednou t\u00fddn\u011b. Celkov\u00e1 doba do n\u00e1vratu hlasu se tak ale prodlu\u017euje. Vzhledem k\u00a0zdokonalov\u00e1n\u00ed kombinovan\u00fdch metod se Na Homolce naopak poda\u0159ilo l\u00e9\u010dbu zkr\u00e1tit.<\/p>\n

\u201eKe zhodnocen\u00ed hlasu vyu\u017e\u00edv\u00e1me v\u00fdsledk\u016f z\u00a0vy\u0161et\u0159en\u00ed z\u00a0hlasov\u00e9ho pole, kde sledujeme s\u00edlu hlasu v\u00a0decibelech a rozsah hlasu v\u00a0p\u016flt\u00f3nech. Rozhoduj\u00edc\u00edm faktorem k\u00a0ukon\u010den\u00ed rehabilitace jsou nejen v\u00fdsledky z\u00a0hlasov\u00e9ho pole, ale i objektivn\u00ed zhodnocen\u00ed hlasu pacienta,\u201c dod\u00e1v\u00e1 Mgr. Ku\u010derov\u00e1<\/p>\n

tiskov\u00e1 zpr\u00e1va
\n<\/b><\/p>\n

Nemocnice Na Homolce<\/b><\/p>\n","protected":false},"excerpt":{"rendered":"

Ztratit \u0159e\u010d m\u016f\u017ee \u010dlov\u011bk nejen po z\u00e1sahu sh\u016fry, jako se to stalo biblick\u00e9mu Zachari\u00e1\u0161ovi. Bez hlasu se ocit\u00e1\u00a0mal\u00e9 procento pacient\u016f po operac\u00edch krku v\u00a0oblasti hrtanu […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":6107,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-18378","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/18378","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18378"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/18378\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/6107"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18378"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18378"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18378"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}